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Do you recognize the importance of measuring patient outcomes but can’t seem to find the time? Have you ever fallen into the trap of having patients fill in a functional survey never to look at it again?

You’ve probably learned to live with the fact that outcome measurement and documentation is here to stay. I believe that documented improvements in your patients’ functional status is the new currency of exchange for therapists. The data you collect on your patients is the proof that your services are extremely valuable and worth the cost.

Rising healthcare costs have increased scrutiny of rehabilitation expenses. Payers are demanding proof that they are getting the maximal value for their dollar. Therapists must prove the necessity of their care at a higher degree than ever before.

There is a difference between self-reported outcomes measures and performance-based ones. Performance-based assessments are directly observed and scored. The time required to perform and calculate even a few tests can be a deterrent for many therapists.

As a result, therapists may rely only on the patient’s perception of their ability to perform a task or activity by answering a questionnaire. Therapists must be diligent to incorporate the scores into the goals and functional treatment plan.

Selecting performance-based tests that are relevant to the patient’s loss of function may serve as motivators and markers for patient functional improvement. Performance based tests immediately reveal to both the patient and therapists the effectiveness of the intervention.

I am a physical therapist in clinical practice (probably like you). I couldn’t be more excited to share my method and tools for performing and documenting functional performance in older adults.

I created a Functional Testing Scorecard to take the hassle and headache out of functional outcome testing and documentation in my clinic. There are many functional tests to choose from but I chose several key assessments to help develop your accuracy, efficiency and confidence. Here are the four steps to my streamlined performance-based functional testing.
Functional testing LEAD MAGNET ICON


Four Steps to Streamlining Your Functional Testing


Step One- Identify The Primary Functional Limitation

During the patient examination ask questions to determine the patient’s primary functional limitation.

  • What was the prior level of function?
  • What is the current level of function?
  • What significant ADL is limited?
  • What activities are needed for independence?
  • What activities is a strong desire for the patient?

Record your initial impressions in functional terms.

Example: “Patient is unable to walk up and down stairs in his home because of knee pain. Before this episode the patient was capable of pain free stair ambulation.”

Step Two- Perform Self-Reported Functional Measurement

Have your patient complete a functional scale or index that corresponds to the diagnosis or functional limitation. For reliability, have supportive personnel assist patient in accurately filing out the form.

For example:

  • Back- Oswestry Disability Index
  • Neck- Neck Disability Index
  • Shoulder- DASH, SPADI, UEFS
  • Hip- LEFS
  • Knee- WOMAC, LEFS


“An 82-year-old male patient is unable to walk up and down stairs in his home because of right knee pain. “

WOMAC functional scale for osteoarthritis of the knee joint is scored to determine ADL limitations due to knee pain.

Step Three- Perform Performance-Based Functional Measurement

Perform a functional performance test(s) that corresponds to the functional limitation or to the patient’s functional goal.

Use the Functional Testing Scorecard to record the patient’s name, age gender and score(s). The Functional Testing Scorecard provides the norms according to age and gender.


Functional testing LEAD MAGNET ICON


Step Four- Calculate the Performance Score Using the Calculator

The Click Here to Download Your Free Scorecard provides a convenient way to quickly convert a test score to an impairment rating. Effort was made for accuracy but not all tests translate easily into the conversion tables.

The user is entirely responsible for using clinical judgment and all clinical data to determine impairment. Impairment should not be exclusively based upon a single functional test score.

If indicated assign a primary functional limitation category, current impairment and goal impairment ratings. Medicare G-code severity modifiers can be assigned as well.

Step Five- Design a Functional Treatment Plan

Now the fun begins when you are able to take the functional performance measurements and use them to formulate goals and your treatment plan. It makes sense that your functional goal be specific to the primary functional limitation.

It is wise to document the rationale of the functional status assessment and functional goal. Include a time frame that is reasonable and achievable.

You should now have a good start on how to effectively measure and document the functional status of your patients. Like most skills, the more you perform them the better and faster you will become.

Don’t let perfectionism get in your way

Much of the functional measurement research was not designed for the variability found in different clinical settings, but they are the best we have for right now. Be realistic with yourself and keep it simple.

Once you have mastered several basic functional tests, you can then start to add to your repertoire. There is no quick and effortless way to gather quality data about your patients’ performance but it doesn’t have to be painfully slow either.

Functional testing is an incredible opportunity for you to prove to patients and outsiders the tremendous value you provide to your patients every day. Make the most out of every patient evaluation and treatment plan by focusing on improving your patient’s quality of life.

The content contained in the Functional Scorecard and Calculator is for informational purposes only. Any instructions or opinions shared are base solely on my own research and experience. It is not a scientific work even though I have done my best to reference the latest evidence based research for my recommendations.



As therapists we have tremendous opportunity to use our abilites, education and expertise to enhance client’s lives. What a privilege? If your are in the therapy business to serve people, then my new book On Fire: Ignite Your Passion with a Cash Therapy Practice will help you.

On Fire takes a close look at innovative therapists who are using alternative ways to deliver high-value care to their patients. Cash therapy services have emerged as a viable alternative to accepting business as usual.

If you are intrigued by the attention that cash-based practices are attracting On Fire is a great primer to help you get up to speed on the key issues and how if might impact your practice. The book is available on Amazon. If you are interested in getting your own copy join my email list and I’ll keep you up to date on the special pre-order bonuses I’m giving away.


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